Enhancing maternal health outcomes.

The World Health Organisation (WHO) aims to end preventable deaths of newborns and children under 5 years of age and reduce maternal mortality.1 Despite progress in reducing maternal and child mortality in South Africa over the last decade, the current rates remain unacceptably high.2 3

Reliable medical information that is easy to access and use can help pregnant women and mothers understand when and where to seek medical care for themselves and their babies. If done right, digital health technology integrated with artificial intelligence represents an opportunity to address these issues.

Over 4 weeks, nearly 1,000 eligible MomConnect users over 18 were enrolled and consented. They then completed surveys about their experience with the symptom assessment and their intention to seek care. Users were contacted one week later to learn about their health-seeking behavior. An independent panel of expert physicians reviewed a number of cases to objectively evaluate the quality of advice provided.

Overall, the findings demonstrated an overwhelmingly positive impact on maternal healthcare and safer health-seeking decisions for mothers and healthcare professionals. Highlighted findings include:

The most common areas of need are respiratory disorders, infectious diseases, and urinary and reproductive illnesses, all of which, if left unaddressed, can pose a substantial risk to both the mother and her child. This research indicates a tangible improvement in the confidence of mothers’ health-seeking behavior and the actual decisions they make.

The study found that more than half of moms who received new treatment, including medication, surgery, and hospital admission, would not have accessed these interventions if they hadn’t checked their symptoms. A significant number of these issues were considered serious, or even potentially life-threatening by their medical provider, and half of those patients were not planning to seek care before using the symptom checker.

Indeed, the number of moms deciding to seek care through primary care, urgent primary care, or emergency care increased by 140%, from 18.1% to 43.5% when comparing intent with behavior. Additionally, the number of moms who opted for self-care at home decreased by 14%, from 63.4% to 54.7%. The study found:

• 98% of mothers found it useful for assessing their symptoms.
• 96% of mothers found it easy to assess their symptoms.
• 98% of Ada's urgency advice was deemed safe by clinicians.

• 1 in 3 women altered their initial health-seeking plans after using the service.
• 41.5% decrease in health-seeking behavior considered unsafe by medical experts.
• 90% reduction in women not knowing what to do.

• Redirecting pregnant women to appropriate care options would also result in short-term cost and time savings. While not the focus of this study, simple economic analysis suggests that the South African healthcare system could have saved ~$65 USD for each person redirected to lower cost or less time-intensive care.

This study is about more than just the usability of a digital health tool; it highlighted the many steps along the path to maternal and infant mortality. Too many mothers present too late, with conditions too advanced for treatment; too many mothers are declining to seek care altogether or don’t recognize the urgency of the symptoms with which they present. Where a mother or child has a potentially infectious disease, failure to seek adequate treatment represents a broader threat to the entire community through unwitting contagion to others. This all contributes in unattributable ways to the high costs and poor outcomes seen in the region.

Acknowledgements

We are so grateful to all the MomConnect users who took part, to all the clinical experts involved across the project, Citizen Surveys, and to the project partners, Reach Digital Health, Ada Health, The Rockefeller Foundation, and the South African National Department of Health.